Overview

Along with
herbal treatment
, touch-based therapy is undoubtedly one of the most ancient forms of medical care. We instinctively stroke and rub areas of our body that hurt; massage therapy develops this instinct into a professional treatment. There is no doubt that massage relieves pain and induces relaxation at least temporarily; besides that, it feels good! Whether it offers any lasting benefits, however, remains unclear.

Forms of Massage

There are many schools of massage. In most cases, massage therapists combine several techniques, although there are also purists who stick to one method. The most common technique is Swedish massage, which combines long strokes and gentle kneading movements that primarily affect surface muscle tissues. Deep-tissue massage utilizes greater pressure to reach deeper levels of muscles. This may be called the “hurts-good-and-feels-great-after” approach. Shiatsu or acupressure massage also uses deep pressure, but according to the principles of
acupuncture
theory. (Acupuncture is so similar to acupressure that we have elected to discuss studies of acupressure in the
acupuncture
article rather than here.) Neuromuscular massage (such as the St. John Method of Neuromuscular Therapy) applies strong pressure to tender spots, technically known as trigger points.

Several other techniques are best described as relatives of massage. Rolfing® Structural Integration aims to affect not muscles, but the connective tissue (fascia) surrounding muscles and everything else in the body. This highly organized technique aims to permanently improve the body’s structure. Reflexology is a form of foot massage based on the theory that the whole body is reflected in the foot.

How Does Massage Work?

There are many theories about how massage might work, but none have been proved true. Little doubt exists that massage temporarily increases blood circulation in the massaged area, but it is not clear that this makes any lasting difference. Some massage therapists and massage therapy schools promote the notion that massage breaks up calcium deposits in the muscle, but there is no objective substantiation for this claim.

A completely different explanation is that massage promotes healing in a more general way, by reducing stress and inducing relaxation. Massage also satisfies the basic human need to be touched.

Some forms of massage (such as Rolfing Structural Integration, acupressure, and reflexology) have elaborate theories behind them. However, there is little to no scientific evidence for these theories
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; moreover, there is some evidence that the theory behind reflexology is incorrect.
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What Is the Scientific Evidence for Massage Therapy?

Although there is some evidence that massage may be helpful for various medical purposes, in general the evidence is not strong.
2
There are several reasons for this, but one is most fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like massage.

Only one form of study can truly prove that a treatment is effective: the
double-blind, placebo-controlled trial
.
(For more information on why such studies are so crucial, see
Why Does This Database Rely on Double-blind Studies?
) However, it isn’t possible to fit massage into a study design of this type. What could researchers use for placebo massage? And how could they make sure that both participants and practitioners would be kept in the dark regarding who was receiving real massage and who was receiving fake massage? The fact is, they can’t.

Because of these problems, all studies of massage fall short of optimum design. Many have compared massage to no treatment. However, studies of this type cannot provide reliable evidence about the efficacy of a treatment. If a benefit is seen, there is no way to determine whether it was caused by massage specifically, or just attention generally. (Attention alone will almost always produce some reported benefit.)

More meaningful trials used some sort of fake treatment for the control group, such as phony laser acupuncture. However, using a placebo treatment that is very different in form from the treatment under study is less than ideal. One study (discussed below) compared real reflexology against fake reflexology. However, it is quite likely that the reflexologists at least unconsciously conveyed more enthusiasm and optimism when performing the real therapy than the fake therapy; this, too, could affect the outcome. It has been suggested that the only way to get around this last problem would be to compare the effectiveness of trained practitioners against actors trained only enough to provide a simulation of treatment; however, such studies have not been reported.

Still other studies have simply involved giving people massages and seeing whether they improved. These trials are particularly meaningless; it has been long since proven that both participants and examining physicians will at least think that they observe improvement in people given a treatment, whether or not the treatment does anything on its own.

Finally, other trials have compared massage to competing therapies, such as
acupuncture
or
relaxation therapy
. Unfortunately, when you compare unproven therapies to each other, the results cannot possibly prove that any of the tested treatments are effective.

Given these caveats, the following is a summary of what science knows about the effects of massage.

Low Back Pain

Although the evidence is far from complete, it does appear that massage may offer benefits for
low back pain
.
3
However, these benefits may last for only short term.

One study compared massage to fake laser therapy in 107 people with low-back pain. The results indicate that massage is more effective than fake laser therapy for relieving low back pain, and that massage therapy combined with exercise and posture training is even more effective.
4

Another study compared acupuncture, massage, and self-care education in 262 people with persistent back pain.
5
By the end of the 10-week treatment period, massage had shown itself more effective than self-care (or acupuncture). However, at a 1-year follow-up, there was no difference in symptoms between the massage group and the self-care group.

In another study, acupressure-style massage was more effective than Swedish massage for the treatment of low back pain.
6

In a review of 13 randomized trials, researchers concluded that massage may be effective for nonspecific low back pain, and the beneficial effects can last for up to 1 year in patients suffering from chronic pain.
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They also noted that exercise and education appear to enhance the effectiveness of massage.
A subsequent large study involving 401 adults (aged 20-65 years old) with nonspecific back pain were randomized to one of three groups: structural massage, relaxation massage, or usual care.
51
At 10 weeks, the patients in the massage groups had improved function and fewer symptoms compared to the usual care group. But unlike the previous review, there were no differences, though, at weeks 26 and 52.

Cancer

Massage therapy has been studied for its benefits in managing the symptoms associated with cancer and its treatment. In a randomized study investigating the effects of massage on 348 advanced cancer patients suffering from moderate to severe pain, the researchers found that, compared to simple touch, massage was significantly more effective at reducing pain and improving mood immediately following treatment, but the effect was not sustained.
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The authors of a review of 10 massage therapy studies were unable to draw firm conclusions about its benefits for a wide range of symptoms in patient undergoing treatment for cancer.
46
A subsequent trial, however, offers tentative evidence that massage therapy may be helpful for people who have bone pain from cancer that has spread. Seventy-two people were randomized to receive massage therapy or simply attention from a therapist for about 40-45 minutes for 3 days in a row.
53
Those in the massage group reported less pain.

Massage without aromatherapy has shown promise for reducing nausea caused by chemotherapy.
41
However, a small randomized trial found that effleurage massage, a common massage technique, had no significant effect on anxiety, depression, or quality of life among 22 women undergoing radiation therapy for breast cancer.
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Other Conditions

Preliminary controlled trials of varying quality suggest that massage may provide benefit in a number of conditions, including the following:

One study found that massaging premature infants 3 times daily for 10 days at
acupressure
locations resulted in greater weight compared to similar infants receiving routine care.
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One study commonly cited as evidence that ordinary massage therapy is helpful for
PMS
was flawed by the absence of a control group.
29
However, a better-designed trial compared reflexology against fake reflexology in 38 women with PMS symptoms and found evidence that real reflexology was more effective.
30

Study results are mixed on whether massage can improve measures of immune function in people with
HIV
.
31-33

One study found that massage is less effective than
acupuncture
for chronic
neck pain
.
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In fact, in this trial massage was no more effective than
fake
acupuncture.

A review of the literature published in 1997 suggests that massage is not helpful for preventing pressure sores (bedsores).
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Several studies indicate that massage combined with
aromatherapy
may be helpful for relieving
anxiety
.
36
One study evaluated this combination therapy for treating anxiety and/or depression in people undergoing treatment for
cancer
.
40
The treatment did appear to provide some short-term benefits.

A 2008 review could find no convincing evidence for the effectiveness of massage therapy against
depression
in general.
42

Researchers analyzed 4 studies investigating the benefits of manual therapy (including massage therapy, joint mobilization, and
manipulation
) for
osteoarthritis
of the hip or knee.
52
The results were inconclusive. Although one of the studies (involving 68 people) did find that massage therapy helped to improve pain and function, it was compared to no intervention rather than another treatment or a placebo.

Interstitial cystitis is a chronic inflammation of the bladder lining of unknown cause, which can lead to c intense pelvic pain. One type of treatment that has been studied for this condition is called myofascial physical therapy. After locating painful and tender sites in the pelvic floor muscles, the therapist manipulates these areas with her fingers to release tight muscle fibers. A study involving 81 women with interstitial cystitis and pelvic area pain were randomized to receive myofascial physical therapy or global (whole-body) massage therapy for 10 treatments.55 Those who received the myofascial approach experienced an improvement in their overall symptoms, but not in bladder pain specifically.

How to Choose a Massage Therapist

As with all medical therapies, it is best to choose a licensed practitioner. Where licensure is not available, your best bet is to seek a referral from a qualified and knowledgeable medical practitioner. However, most US states license massage therapists.

Note that massage, like other hands-on therapies, involves personal talents that go beyond specific training, certification, or licensure: Some people are simply gifted with their hands. Furthermore, what works for one person may not work for another. For these reasons, some trial and error is often necessary to find the best massage therapist for you.

Safety Issues

Massage is generally safe.
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However, it can sometimes exacerbate pain temporarily, even when properly performed. In addition, if massage is performed too forcefully on fragile people, bone fractures and other internal injuries are possible. However, licensed massage therapists have been trained in ways to avoid causing these problems. Machines designed to perform elements of massage may be less safe.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY.
Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.